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Publications

Journal Article Ahead of print

PubMed: 41661171 DOI: 10.1097/MCG.0000000000002344

Risk Stratification and Validation of ICU Scores in Prediction of Post-ERCP Mortality for Critically Ill Patients With Severe Acute Cholangitis Based on Tokyo Guidelines 2018.

J Clin Gastroenterol

Authors: Esam Elshimi, Tamer Refaat Fouad, Wael M Abdel-Razek, Sara Ramadan Nassar, El Sayed Shaaban Tharwa, Mohammed Akl Rady, Heba Demerdash, Imam Waked, Ahmed Attia

Affiliations

  • Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University.
  • Department of Hepatology and Gastroenterology, National Liver Institute, Shebeen Al-Kom, Menoufia, Egypt.

Abstract

BACKGROUND

SOFA, APACHE II, and SAPS II scores have not been systematically validated for mortality prediction in patients with severe acute cholangitis (SAC) classified by the Tokyo Guidelines 2018. This study aimed to determine the value of these scores in predicting mortality in SAC.

METHODS

This prospective observational study was conducted in a tertiary center from January 2022 to May 2023. The mortality predictive scoring systems: SOFA, APACHE II, and SAPS II were calculated and compared in 175 SAC patients (classified by TG18) who underwent ERCP.

RESULTS

Mean age 60.9±12.7, male/female 114/61, the mean time from ICU admission to ERCP: 15.8 hours. ICU mortality n=33; 18.9%. Factors associated with high mortality: age older than or equal to 75 years, high respiratory rate, total bilirubin, blood urea nitrogen, and creatinine; low Na, hemoglobin, hematocrit, PaO2/FiO2 ratio, urine output, HCO3, and Glasgow Coma Scale; malignant cause of biliary obstruction, the need for vasopressors or mechanical ventilation and the presence of septic shock and liver cirrhosis. SOFA score (survivors vs. deceased mean±SD: 4.7±1.7, 8.6±2.1; P=0.001), APACHE II score (13.7±3.8, 15±5.5; P=0.011), and SAPS II score (52±8.4, 59.6±9.9; P=0.021), but only SOFA score could independently predict ICU mortality (adjusted odds ratio; 95% CI: 1.241, 1.09-4.1). ROC curve AUC for SOFA, APACHE II, and SAPS II (0.89, 0.69, and 0.61, respectively). Limitations of this study included (a single-center study and inclusion of patients with cirrhosis).

CONCLUSIONS

The scores above are valuable in predicting mortality in ASC and add further value to TG18.

MeSH

Cholangiopancreatography, Endoscopic Retrograde, Mortality, Cholangitis, Gastroenterology, Critical Illness, Intensive Care Units